TY - JOUR
T1 - Efficacy of statins in familial hypercholesterolaemia: a long term cohort study
AU - Versmissen, Jorie
AU - Oosterveer, Daniëlla M.
AU - Yazdanpanah, Mojgan
AU - Defesche, Joep C.
AU - Basart, Dick C. G.
AU - Liem, Anho H.
AU - Heeringa, Jan
AU - Witteman, Jacqueline C.
AU - Lansberg, Peter J.
AU - Kastelein, John J. P.
AU - Sijbrands, Eric J. G.
PY - 2008
Y1 - 2008
N2 - Objective To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia. Design Cohort study with a mean follow- up of 8.5 years. Setting 27 outpatient lipid clinics. Subjects 2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990. Main outcome measures Risk of coronary heart disease in treated and "untreated" ( delay in starting statin treatment) patients compared with a Cox regression model in which statin use was a time dependent variable. Results In January 1990, 413 ( 21%) of the patients had started statin treatment, and during follow- up another 1294 patients ( 66%) started after a mean delay of 4.3 years. Most patients received simvastatin ( n= 1167, 33 mg daily) or atorvastatin ( n= 211, 49 mg daily). We observed an overall risk reduction of 76% ( hazard ratio 0.24 ( 95% confidence interval 0.18 to 0.30), P <0.001). In fact, the risk of myocardial infarction in these statin treated patients was not significantly greater than that in an age- matched sample from the general population ( hazard ration 1.44 ( 0.80 to 2.60), P= 0.23). Conclusion Lower statin doses than those currently advised reduced the risk of coronary heart disease to a greater extent than anticipated in patients with familial hypercholesterolaemia. With statin treatment, such patients no longer have a risk of myocardial infarction significantly different from that of the general population
AB - Objective To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia. Design Cohort study with a mean follow- up of 8.5 years. Setting 27 outpatient lipid clinics. Subjects 2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990. Main outcome measures Risk of coronary heart disease in treated and "untreated" ( delay in starting statin treatment) patients compared with a Cox regression model in which statin use was a time dependent variable. Results In January 1990, 413 ( 21%) of the patients had started statin treatment, and during follow- up another 1294 patients ( 66%) started after a mean delay of 4.3 years. Most patients received simvastatin ( n= 1167, 33 mg daily) or atorvastatin ( n= 211, 49 mg daily). We observed an overall risk reduction of 76% ( hazard ratio 0.24 ( 95% confidence interval 0.18 to 0.30), P <0.001). In fact, the risk of myocardial infarction in these statin treated patients was not significantly greater than that in an age- matched sample from the general population ( hazard ration 1.44 ( 0.80 to 2.60), P= 0.23). Conclusion Lower statin doses than those currently advised reduced the risk of coronary heart disease to a greater extent than anticipated in patients with familial hypercholesterolaemia. With statin treatment, such patients no longer have a risk of myocardial infarction significantly different from that of the general population
U2 - https://doi.org/10.1136/bmj.a2423
DO - https://doi.org/10.1136/bmj.a2423
M3 - Article
C2 - 19001495
SN - 0959-8138
VL - 337
SP - a2423
JO - BMJ (Clinical research ed.)
JF - BMJ (Clinical research ed.)
ER -